Indapamide — NZ Medication Guide

What is Indapamide?

Indapamide (generic name: indapamide) is a medication used primarily for hypertension (high blood pressure) and prevention of cardiovascular events. Indapamide is funded by Pharmac on the Pharmaceutical Schedule. Both immediate-release and modified-release (SR) formulations are available in New Zealand.

In New Zealand, indapamide is endorsed by BPAC NZ as a preferred thiazide-like diuretic for hypertension, particularly in combination therapy. The ADVANCE trial demonstrated that indapamide plus perindopril significantly reduced cardiovascular events and mortality in patients with Type 2 diabetes — this combination (Preterax/Coversyl Plus) is available in NZ. Electrolyte monitoring is essential, particularly in elderly patients and those on other diuretics or ACE inhibitors.

What is Indapamide Used For?

Indapamide is prescribed by healthcare professionals in New Zealand for the following indications:

• Essential hypertension (primary high blood pressure)
• Reduction of cardiovascular risk in patients with Type 2 diabetes and hypertension
• Adjunct therapy in oedema (fluid retention) associated with heart failure

How Does Indapamide Work?

Indapamide is a thiazide-like diuretic that works primarily on the distal convoluted tubule of the kidney, reducing sodium and water reabsorption to lower blood pressure. At low antihypertensive doses, its diuretic effect is modest; its blood pressure-lowering action is predominantly through vasodilation — reducing peripheral vascular resistance. This dual mechanism makes it effective and well-tolerated at low doses.

How to Take Indapamide

Take indapamide once daily, usually in the morning, with or without food. Swallow modified-release tablets whole without crushing or chewing. Take at the same time each day for consistent blood pressure control. Do not stop abruptly without consulting your doctor. Regular monitoring of electrolytes (potassium, sodium) and kidney function is recommended.

Common Side Effects

Like all medications, Indapamide may cause side effects. Common side effects include:

• Hypokalaemia (low potassium) — muscle cramps, weakness
• Hyponatraemia (low sodium) — particularly in elderly patients
• Dizziness, especially on standing (orthostatic hypotension)
• Headache
• Increased urination (less pronounced than with loop diuretics)
• Mild rash or photosensitivity

Serious Side Effects — Seek Medical Attention

Contact your doctor or call 111 immediately if you experience any of the following serious effects:

• Severe electrolyte disturbances — low potassium, low sodium, low magnesium
• Acute kidney injury in dehydrated patients or those on NSAIDs
• Severe allergic skin reaction (Stevens-Johnson syndrome — rare)
• Hypovolaemia (dehydration) in hot weather or illness

Drug Interactions

Always inform your prescriber and pharmacist of all medications, supplements, and herbal products you are taking. Notable interactions with Indapamide include:

• Lithium — indapamide reduces lithium excretion; lithium toxicity risk
• NSAIDs (ibuprofen, naproxen) — reduce antihypertensive effect; increase renal toxicity risk
• Potassium-wasting diuretics — additive hypokalaemia
• Digoxin — hypokalaemia increases risk of digoxin toxicity
• ACE inhibitors/ARBs — combination with diuretics can cause first-dose hypotension

New Zealand Prescribing Information

In New Zealand, indapamide is endorsed by BPAC NZ as a preferred thiazide-like diuretic for hypertension, particularly in combination therapy. The ADVANCE trial demonstrated that indapamide plus perindopril significantly reduced cardiovascular events and mortality in patients with Type 2 diabetes — this combination (Preterax/Coversyl Plus) is available in NZ. Electrolyte monitoring is essential, particularly in elderly patients and those on other diuretics or ACE inhibitors.

Frequently Asked Questions

How is indapamide different from bendroflumethiazide?

Both are diuretics used for hypertension, but indapamide is a thiazide-like diuretic with additional vasodilatory properties. At standard antihypertensive doses, indapamide has fewer metabolic side effects (less impact on glucose, lipids, and uric acid) compared to older thiazide diuretics, making it a preferred option in many guidelines including BPAC NZ.

Do I need blood tests while taking indapamide?

Yes. Indapamide can lower potassium, sodium, and magnesium levels in the blood, particularly at higher doses or in combination with other medications. Your doctor will arrange blood tests to check your electrolytes and kidney function — usually after 1–4 weeks of starting treatment, and then at regular intervals. Report muscle cramps, weakness, or unusual thirst to your doctor promptly.

References & Further Information

The following New Zealand and international resources were used to inform this page:

• New Zealand Formulary — Indapamide
• Pharmac — Funded Medicines Schedule
• BPAC NZ — Managing Hypertension
• Medsafe — Indapamide Data Sheet

Reviewed by a Registered Pharmacist — KiwiMeds New Zealand